CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Akinci, S. B.
Right arrow Articles by Kanbak, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Akinci, S. B.
Right arrow Articles by Kanbak, M.
Canadian Journal of Anesthesia 50:423-424 (2003)
© Canadian Anesthesiologists' Society, 2003

Correspondence

Analgesic effect of intra-articular tramadol compared to morphine after arthroscopic knee surgery

Seda B. Akinci, MD, Fatma Saricaoglu, MD, Ahmet Atay, MD, Mahmut N. Doral, MD and Meral Kanbak, MD

Ankara, Turkey

To the Editor:

Intra-articularly administered morphine has been studied extensively and shown to have a definite but mild analgesic effect.1 Although parenteral tramadol, an analgesic drug with some {alpha}2-adrenergic and opioid receptor agonist activity, produces analgesia equivalent to parenteral morphine in moderate postoperative pain, the efficacy of intra-articular (IA) tramadol remains unclear.2 We compared the analgesic effect of IA morphine with IA tramadol. Seventy-five patients, having elective arthroscopic surgery of the knee were randomized to receive either IA tramadol 50 mg, IA morphine 5 mg or IA normal saline 20 mL. The tourniquet was released ten minutes after analgesic administration. Exclusion criteria were preoperative narcotic use, contraindication to narcotics, seizure disorder, anterior cruciate ligament reconstruction, and traumatic injury to the knee.

We did not observe any differences among the three groups with respect to age, gender, weight, duration of surgery, surgical procedures, laser use during surgery, duration and severity of preoperative knee pain, time to discharge or side effects. There was also no difference with respect to pain scores or the use of rescue analgesics postoperatively, except for the first pain score when the patients arrived to the postanesthesia care unit and the time to first rescue analgesic (TableGo).


View this table:
[in this window]
[in a new window]
  		TABLE Patient data
 
The dose and volume of morphine used in this study was based on our previous experience.3 We believe duration and severity of the preoperative symptoms and pain can change the effectiveness of the postoperative analgesic. There was a good correlation between the duration of preoperative pain symptoms and time to first analgesic requirement after the operation (r2 = 0.731, P < 0.0001). Experimental and clinical evidence shows that analgesic effects of peripheral opioids and the density of opioid receptors on peripheral sensory nerves increase with the duration of painful inflammatory processes.4 After examining different time intervals, in the subgroup of patients with more than six months of preoperative pain (14 patients in the morphine and the control groups, ten patients in the tramadol group), the analgesic effects of IA narcotics were more prominent (TableGo). These patients benefited from the IA administration of tramadol or morphine, having had a chance to increase the expression of peripheral receptors.

We conclude that morphine and tramadol, at the doses used, provide similar analgesia when given intra-articularly. The mechanisms of action of IA opioids are yet to be elucidated.1 Further studies are needed to compare the adverse effects between IA morphine and tramadol. We believe IA tramadol can be an alternative to IA morphine for postoperative analgesia after arthroscopic surgery, especially in patients with more than six months of preoperative pain.

References

1 Gupta A, Bodin L, Holmstrom B, Berggren L. A systematic review of the peripheral analgesic effects of intraarticular morphine. Anesth Analg 2001; 93: 761–70.[Abstract/Free Full Text]

2 Power I, Barratt S. Analgesic agents for the postoperative period. Nonopioids. Surg Clin North Am 1999; 79: 275–95.[Medline]

3 Kanbak M, Akpolat N, Ocal T, Doral MN, Ercan M, Erdem K. Intraarticular morphine administration provides pain relief after knee arthroscopy. Eur J Anaesthesiol 1997; 14: 153–6.[Medline]

4 Likar R, Schafer M, Paulak F, et al. Intraarticular morphine analgesia in chronic pain patients with osteoarthritis. Anesth Analg 1997; 84: 1313–7.[Abstract]





This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Akinci, S. B.
Right arrow Articles by Kanbak, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Akinci, S. B.
Right arrow Articles by Kanbak, M.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS